GLP1‐RA Add‐on Therapy in Patients with Type 2 Diabetes Currently on a Bolus Containing Insulin Regimen

Adding glucagon‐like peptide‐1 receptor agonists ( GLP ‐1 RA s) to basal insulin regimens has become a guideline‐recommended treatment option for uncontrolled type 2 diabetes. However, limited data exist to support the use of GLP ‐1 RA s with insulin regimens, including bolus insulin in patients with type 2 diabetes. The primary objectives of this review were to identify if the combination of a GLP ‐1 RA and an insulin regimen containing bolus insulin resulted in improvements in HbA 1c , weight loss, reduction in insulin doses, and to evaluate the side effect profile of this combination in terms of nausea and hypoglycemia risk. Eight studies using exenatide twice/day , liraglutide, and dulaglutide were reviewed ranging in average duration of follow‐up from 3 to 15 months. Seven studies showed that addition of a GLP ‐1 RA was associated with significant HbA 1c reductions ranging from 0.4% to 1.64% from baseline to follow‐up. Patients in all eight studies had significant weight loss in the GLP ‐1 RA arm from baseline to follow‐up ranging from 0.87 to 10.2 kg. In all the studies, total daily bolus insulin doses decreased 25–67% from baseline to follow‐up. In some studies, a portion of patients were able to discontinue bolus insulin all together after initiation of a GLP ‐1 RA . In addition, in two randomized trials included in the review, the GLP ‐1 RA arm showed significant improvement in HbA 1c and weight compared with the control group who received basal/bolus regimens. Nausea was identified in 7–42% of participants using GLP ‐1 RA s with insulin. Data support the use of GLP ‐1 RA s added to insulin regimens already containing bolus insulin for glycemic control, weight loss, and reduction or discontinuation of bolus insulin.